Do you have any thoughts on follow-up in patients after liver transplantation in context of fatty liver disease? In light of fact of possible negative influence of immunosupressive drugs (i.e sterodis, takrolimus, sirolimus) on metabolism, and induced risk of metabolic disturbances, like increased insulin resistance, diabetes do you have any experiences on monitoring the patients on risk of fatty liver/NASH? Finally, does adipokines activity change after transplantation and is there any data on influence of immunosupressive drugs on onset of fatty liver diseases?
@WeiWang - thank you for suggestion of great article. I think that living-donor transplants are still more popular in Asia than in Europe, but due to lack of donors, it seems that this way of transplantation will gain popularity in the future.
@ Luis - what do you think about it? What is the situation in Spain nowadays?
In Poland, statistics for 2014 is 336 transplantations from deceased donors vs 30 transplantations of liver fragments from living donors. This shows great potential in living-donor transplantation, and brings many questions like Wei suggested. (link no 1)
I am wondering how does situation look like in your perspective, regarding post-transplant fatty liver/NASH monitoring, in context of immunosupresive therapy (steroids, calcineurin inhibitors) which does affect metabolism in crucial way and may lead to liver injury connected with fat accumulation.
Adiponectin (protective adipokine - usually down-regulated in Non Alcoholic Fatty Liver Disease and NASH) was investigated in some studies in liver-transplant patients. Those studies have shown higher adiponectin levels than in NASH patients
Adiponectin, an anti-inflammatory adipokine that acts as an anti-obesity hormone, is usually down-regulated in NAFLD[27]. Few studies have investigated adiponectin in LT patients. In the present study, the LT recipients had higher adiponectin levels than the NASH patients, and there were no differences between the patients and controls.
However, as immunsupressive therapy is a life-time treatment, we should reme,ber that steroids and calcineurin inhibitors are related to high risk of metabolic syndrome (link no 2). Calcineurin inhibitors (tacrolimus - usualy used after liver transplant). They casuse renal injury as well, and increase oxidative stress which also increases risk of fatty liver diseases.
Calcineurin inhibitors are also linked to renal injury and are prone to increase oxidative stress and lipid peroxidation.
http://www.poltransplant.org.pl/statystyka_2014.html
http://www.ncbi.nlm.nih.gov/pubmed/23639094
Obesity, diabetes, hypertension, renal failure (civilization diseases)
Recidivism of alcoholism and HCV infection
Hepatic diseases: hepatitis C, recurrent HCC, recurrent alcoholism and fatty liver.
Extrahepatic diseases: Cardiovascular risk factors and renal failure are very important problems, but malignancy is a growing problem in most transplant centers.
http://www.ncbi.nlm.nih.gov/pubmed/19877025
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